甲状腺韧带解剖的再认识以及甲状腺手术新路径的研究  

Recognition of the ligament of thyroid and study of a new surgical approach to thyroid gland

作　　者：汤治平[1] 梁志宏[1] 赵象文[1] 梁志成[1] 陈建安[1] 丁纪伟[1] 刘书强[1] 华伟[1] 

机构地区：[1]中山市小榄人民医院(南方医科大学附属小榄医院)普外科,528415

出　　处：《中华普通外科学文献（电子版）》2009年第2期36-38,共3页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的探讨气管前筋膜、外侧韧带(Berry韧带)、悬韧带在甲状腺固定中的作用,以及易于解除甲Υ腺固定的中间入路新手术路径的效果。方法采取甲状腺中间入路的手术方法完成甲状腺手术326例。术中常规切断游离气管前筋膜、外侧韧带、悬韧带,解除甲状腺固定(即甲状腺松动)。结果本组术中甲状腺松动的完成率为98.5%(321/326)。手术平均时间75(45～130)min。术中平均出血量23(5～126)ml。2例再次甲状腺手术和3例甲状腺癌手术出现轻度喉返神经麻痹症状,分别于1、3、6个月后恢复,无⒗久损伤。术后平均Α院时间4.5(3～6)d。结论中间入路新手术路径的目的是首先解除气管前筋膜、外侧韧带、悬韧带对甲Υ腺的固定,甲Υ腺得以松动后再进行血管游离以及其他手术步骤,使甲Υ腺的切除手术变得容易操作,同时使手术并发症减少。Objective To investigate the function of the ligament of Berry, the suspended ligament in fixed thyroid and the results of the new surgical approach to remove the fixed throid gland. Methods The new surgical approach in middle route had been performed at the 326 patients in thyroid surgery. The pretrachealis fascia, the ligament of Berry and the suspended ligament had been cut off to dismiss thyroid. Results 98.5% of fixed thyroid gland were loosed. Mean operating tithe was 75（45-130） minites. The operation bleeding was 23（5-126） ml. The recurrent laryngeal nerve paralysis occurred in two patients with thyroid adenoma and three patients with thyroid adenocarcinoma who recovered 1, 3, 6 months later. The mean length of stay was 4.5（3-6） days. Conclusions The purpose of the surgical approach in middle route is to loose the pretrachealis fascia, the ligament of Berry first, with other operation steps such as blood vessel dissection following on. The new approach is easier than the conventional method with less complication.

关 键 词：甲状腺 气管前筋膜 外侧韧带 悬韧带 喉返神经 手术路径 

分 类 号：R653[医药卫生—外科学] R686.5[医药卫生—临床医学]